A 25-year-old patient presented to the clinic, where the physician was practicing, complaining of nausea and localized lower abdominal pain that had been present for eight to nine days. The patient showed an elevated pulse of 120 and temperature of 99.8 degrees, indicating that he was in some discomfort. An APN initially examined the patient and ordered an abdominal x-ray. The initial examination and testing completed by the APN was inadequate and poorly documented. The medical records do not include sufficient or clear data on findings related to the history or nature of the pain, specific location, factors that increase or decrease the pain, or other standard diagnostic criteria necessary to rule out all possible diagnoses indicated by the patient’s abnormal vital signs and abdominal pain reported, such as acute appendicitis or other diseases of the intestine and colon. The physician viewed the APN’s examination notes, re-palpated the patient’s abdomen, and assisted in reviewing the x-ray, which was interpreted by the radiologist as negative for findings. The physician failed to document consideration of all possible conditions indicated by the patient’s reported symptoms and abnormal vital signs, personally perform an appropriate evaluation of the patient that included a rectal examination, or order all necessary testing indicated by the patient’s abnormal vital signs and symptoms reported, which should have included a complete blood count test. The physician diagnosed the patient with non-specific abdominal pain and prescribed medications for the treatment of irritable bowel syndrome, acid reflux disease, and nausea. Two days later, the patient presented to an emergency room and was diagnosed with a ruptured appendix. The physician does not admit or deny these Findings of Fact, set forth in this Agreed Order.

Action Taken:

The Texas Medical Board Orders that the physician shall be subject, but not limited to, the following terms and conditions:

The physician shall successfully complete the Knowledge, Skills, Training, Assessment, and Research (KSTAR) program’s Clinical Competency Assessment, within one year from the date of entry of this Order.

The physician shall successfully complete at least twenty hours of CME approved for Category I credits.

The physician shall comply with all the provisions of the Act and other statutes regulating her practice.

The physician shall fully cooperate with the Board and the Board staff.

The physician shall be permitted to supervise and delegate prescriptive authority to physician assistants and advanced practice nurses and to supervise surgical assistants.

This Order shall automatically terminate upon the physician’s submission of sufficient evidence that she successfully completed the requirements ordered in the terms in numbers one and two above.